Healthcare Provider Details

I. General information

NPI: 1881437135
Provider Name (Legal Business Name): GILBERTO LOZANO, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11629 LOWER AZUSA RD STE H
EL MONTE CA
91732-1389
US

IV. Provider business mailing address

11629 LOWER AZUSA RD STE H
EL MONTE CA
91732-1389
US

V. Phone/Fax

Practice location:
  • Phone: 626-672-0224
  • Fax:
Mailing address:
  • Phone: 626-672-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN GILBERTO LOZANO
Title or Position: OWNER
Credential: DDS
Phone: 626-672-0224